A Health Tech Monopoly – II

A competitive marketplace would produce the most innovative medical-records system.

Updated April 14, 2009 12:01 a.m. ET

The New England Journal of Medicine is the holy scripture of the medical academic left, so it's worth noting that the magazine has just punched a hole in the many blandishments about electronic medical records.

Recall that the recent stimulus devotes $19 billion to encourage doctors and hospitals to adopt digital recordkeeping in lieu of the paper systems prevalent today -- and penalizes them beyond 2015 if they don't. While the New England Journal grants that more and better clinical information could yield modest benefits, it is also clearly perturbed with the government's new role as the arbiter of health information technology.

In a "perspective" akin to an editorial, Kenneth Mandl and Isaac Kohane, both health-tech specialists at Children's Hospital Boston and Harvard Medical School, write that "flexibility is critical" as Congress promotes electronic medical records. The ideal system would be an open platform for many developers to write applications that are allowed to succeed and fail, much like Apple's iPhone software. They argue that the key is "allowing competition and 'natural selection' for high-value, low-cost products. This approach contrasts sharply with design of a national system by committee."

Drs. Mandl and Kohane's critique is couched in the staid language of a peer-reviewed journal, but the implications are obvious. The stimulus hands the Obama Administration the power to define and approve "certified" records, therefore the power to create a health-tech monopoly. With stimulus money being shoveled out as quickly as possible, doctors and hospitals may end up prematurely investing in the costly systems that happen to have the government seal of approval -- and in the process freezing out an innovative marketplace.

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